Shoulder Dystocia and Erb’s Palsy: When Delivery Complications Lead to Birth Injuries

Most childbirths proceed without major complications, but some deliveries require healthcare providers to make rapid, well-informed decisions to protect both mother and baby. One of the most serious obstetrical emergencies is shoulder dystocia, a complication that can place tremendous stress on a baby’s neck and shoulders during delivery. If healthcare providers fail to respond appropriately, the baby may suffer a brachial plexus injury that results in Erb’s palsy or other permanent impairments.

While not every case of shoulder dystocia results from medical negligence, some birth injuries are preventable. When doctors fail to recognize risk factors, improperly manage a difficult delivery, or use excessive force during childbirth, families may have grounds for a California medical malpractice claim. At Kalfayan Merjanian, LLP, we help families investigate whether preventable delivery errors contributed to a child’s birth injury.

What Is Shoulder Dystocia?

Shoulder dystocia occurs when, after the baby’s head has been delivered, one or both shoulders become lodged behind the mother’s pelvic bone, preventing the rest of the baby’s body from being delivered normally. Because the baby may remain partially trapped in the birth canal, shoulder dystocia is considered a true obstetrical emergency. Healthcare providers must act quickly to safely complete the delivery while minimizing the risk of injury to both mother and child. Although shoulder dystocia cannot always be predicted or prevented, obstetricians and labor and delivery teams are expected to recognize the emergency promptly and follow accepted medical procedures to resolve it.

What Is Erb’s Palsy?

Erb’s palsy is a type of brachial plexus injury involving damage to the network of nerves that controls movement and sensation in the shoulder, arm, and hand. These nerves can become stretched or torn if excessive force is applied to the baby’s head or neck during delivery. The resulting injury may affect the baby’s ability to move the affected arm normally. Some children recover fully with therapy, while others experience permanent weakness, reduced range of motion, muscle atrophy, or lifelong functional limitations. More severe nerve injuries may require reconstructive surgery or nerve graft procedures.

How Does Shoulder Dystocia Cause Erb’s Palsy?

When a baby’s shoulder becomes stuck during delivery, healthcare providers must carefully use recognized obstetrical maneuvers designed to free the shoulder without placing excessive tension on the brachial plexus nerves. Problems can arise if providers panic, pull excessively on the baby’s head or neck, or attempt forceful extraction rather than using accepted techniques.

The injury often occurs not because shoulder dystocia happened, but because excessive traction or improper delivery techniques caused unnecessary stretching or tearing of the nerves. This distinction is important because the presence of shoulder dystocia alone does not establish negligence. Instead, the question is whether the healthcare providers responded in accordance with the accepted standard of care.

Could Shoulder Dystocia Have Been Anticipated?

Shoulder dystocia sometimes develops unexpectedly. However, certain pregnancies involve known risk factors that may increase the likelihood of this complication. These risk factors may include:

• A larger-than-average baby (fetal macrosomia)
• Maternal diabetes
• Maternal obesity
• A history of shoulder dystocia during a previous delivery
• Prolonged labor
• Assisted vaginal delivery using forceps or vacuum extraction

The presence of one or more risk factors does not necessarily mean shoulder dystocia will occur. Likewise, shoulder dystocia can develop even when no identifiable risk factors are present. Nevertheless, physicians are expected to consider these factors when planning the safest method of delivery.

What Medical Errors Can Lead to an Erb’s Palsy Claim?

Birth injury malpractice claims involving shoulder dystocia often focus on whether healthcare providers followed accepted obstetrical practices before and during delivery. Examples of potential negligence include failing to recognize significant risk factors, inadequately preparing for a difficult delivery, improperly managing shoulder dystocia after it occurs, using excessive force during delivery, or failing to timely consider whether a cesarean delivery may have been appropriate under the circumstances. Every case requires careful analysis of the medical records because the appropriate course of action depends on the specific facts of the pregnancy and delivery.

What Are the Long-Term Effects of Erb’s Palsy?

The impact of Erb’s palsy varies depending on the severity of the nerve injury. Some children experience gradual improvement through physical therapy and occupational therapy during infancy and early childhood. Others continue to have permanent weakness, limited shoulder movement, reduced grip strength, or difficulty performing everyday activities. In more severe cases involving torn nerves or nerve root avulsion, children may require multiple surgeries and years of rehabilitation. Long-term limitations can affect participation in sports, school activities, future employment, and overall quality of life. Because children with permanent brachial plexus injuries may require ongoing treatment for many years, the financial and emotional burden on families can be substantial.

How Is Medical Negligence Proven in a Shoulder Dystocia Case?

Not every brachial plexus injury is the result of malpractice. Some injuries occur despite healthcare providers exercising appropriate medical judgment and following accepted delivery techniques. To establish negligence, it is generally necessary to show that the healthcare providers failed to meet the applicable standard of care and that this failure directly caused the child’s injury. Investigating these cases often requires reviewing labor and delivery records, physician notes, nursing documentation, fetal monitoring records, delivery timelines, and neonatal evaluations. Qualified medical experts play an essential role in determining whether the obstetrical team responded appropriately to the shoulder dystocia emergency and whether different actions could have prevented the injury.

Why Is Expert Testimony So Important in Birth Injury Cases?

California birth injury cases frequently involve complex medical questions that require expert analysis. Obstetricians, maternal-fetal medicine physicians, pediatric neurologists, pediatric orthopedic specialists, and other qualified experts may evaluate whether the delivery complied with accepted medical standards and whether excessive traction or other negligent actions caused the brachial plexus injury. Experts may also help explain the child’s long-term prognosis, anticipated future medical needs, rehabilitation costs, and permanent functional limitations. Their testimony is often critical in helping establish both liability and the full extent of the damages suffered by the child and family.

Contact Kalfayan Merjanian, LLP After a Birth Injury at a California Hospital

If your child was diagnosed with Erb’s palsy or another brachial plexus injury following a difficult delivery involving shoulder dystocia, you may have questions about whether the injury could have been prevented. Determining whether medical negligence occurred often requires a detailed review of the delivery records and consultation with qualified medical experts. Kalfayan Merjanian, LLP represents California families in complex birth injury malpractice cases and is committed to helping parents pursue accountability when preventable medical errors cause lifelong harm. Contact Kalfayan Merjanian, LLP today to discuss your family’s legal options.